- Humana (Atlanta, GA)
- …part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to ... to prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and frequently...skills to make an impact** **Required Qualifications** + Active Registered Nurse license in a state that is part… more
- Humana (Atlanta, GA)
- …to assess outcome and metrics of market compliance with NCQA must pass UM elements. + ** Audit Calibration:** Verify findings to maintain data quality and ... Role:** Serve as key advisors to market management on compliance -related matters related to audit findings. +...Peer Review Literature, etc. + Working knowledge of NCQA UM letter requirements and compliance best practices.… more
- Molina Healthcare (Atlanta, GA)
- …within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including ... The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as… more